Abstract 3526: Medication Non-adherence Is Associated With A Broad Range Of Adverse Outcomes In Patients With Coronary Artery Disease
Background: Little is known about the effect of non-adherence among coronary artery disease (CAD) patients on a broad spectrum of outcomes including cardiovascular mortality, cardiovascular hospitalizations or revascularization procedures.
Methods: This was a retrospective cohort study of 15,767 patients with CAD in a managed care organization. Medication adherence was calculated as proportion of days covered (PDC) for filled prescriptions of β-blockers, ACE-inhibitors, and statin medications. Multivariable Cox regression assessed the association between medication non-adherence as a time-varying covariate and mortality (all-cause and cardiovascular), adjusting for demographics and clinical characteristics. Median follow-up was 4.1 years.
Results: Across the three classes of medications, non-adherent patients were more likely to be younger and have a diagnosis of COPD or depression. In unadjusted analysis, non-adherence to each individual class of medication was associated with higher all-cause and cardiovascular mortality. In multivariable analysis, non-adherence remained significantly associated with increased all-cause mortality risk for β-blockers (HR 1.50; 95% CI 1.33–1.71), ACE-inhibitors (HR 1.74; 95% CI 1.52–1.98), and statins (HR 1.85; 95% CI 1.63–2.09). In addition, non-adherence remained significantly associated with higher risk of cardiovascular mortality for β-blockers (HR 1.53; 95% CI 1.16 –2.01), ACE-inhibitors (HR 1.66; 95% CI 1.26 –2.20), and statins (HR 1.62; 95% CI 1.124 –2.13). The findings of increased risk associated with non-adherence were consistent for cardiovascular hospitalization and revascularization procedures.
Conclusions: Non-adherence to cardioprotective medications is associated with a broad range of adverse outcomes. These findings support the importance of non-adherence in clinical practice and suggest that medication non-adherence should be a target for future interventions.